Objective: To evaluate the utility of high-frequency physiologic data during the extubation process and other clinical variables for describing the physiologic pro le of extubation failure in neonates with hypoplastic left heart syndrome (HLHS) post-Norwood procedure.Methods: Single-center, retrospective analysis. Extubation events were collected from January 2016 until July 2021. Extubation failure was de ned as the need for re-intubation within 48 hours of extubation. The data included streaming heart rate, respiratory rate, blood pressure, arterial oxygen saturation, and cerebral/renal near-infrared spectroscopy (NIRS). The most recent blood laboratory results before extubation were also included. These markers, demographics, clinical characteristics, and ventilatory settings were compared between successful and failed extubations.Results: The analysis included 311 extubations. The extubation failure rate was 10%. According to univariate analyses, failed extubations were preceded by higher respiratory rates (p=0.029), lower endtidal CO2 (p=0.009), lower pH (p=0.043), lower serum bicarbonate (p=0.030), and lower partial pressure of O2 (p=0.022). In the rst 10 minutes after extubation, the failed events were characterized by lower arterial (p=0.028) and cerebral NIRS (p=0.018) saturations. Failed events were associated with persistently lower values for cerebral NIRS 2 hours post-extubation (p=0.027). In multivariate analysis, vocal cord anomaly, cerebral NIRS at 10 minutes post-extubation, renal NIRS at pre-extubation and postextubation, and end-tidal CO2 at pre-extubation remained as signi cant co-variates.Conclusions: Oximetric indices before, in the 10 minutes immediately after, and 2 hours after extubation and vocal cords paralysis are associated with failed extubation events in patients with parallel circulation.

Objective: To evaluate the utility of high-frequency physiologic data during the extubation process and other clinical variables for describing the physiologic profile of extubation failure in neonates with hypoplastic left heart syndrome (HLHS) post-Norwood procedure. Methods: Single-center, retrospective analysis. Extubation events were collected from January 2016 until July 2021. Extubation failure was defined as the need for re-intubation within 48 hours of extubation. The data included streaming heart rate, respiratory rate, blood pressure, arterial oxygen saturation, and cerebral/renal near-infrared spectroscopy (NIRS). The most recent blood laboratory results before extubation were also included. These markers, demographics, clinical characteristics, and ventilatory settings were compared between successful and failed extubations.Results: The analysis included 311 extubations. The extubation failure rate was 10%. According to univariate analyses, failed extubations were preceded by higher respiratory rates (p=0.029), lower end-tidal CO2 (p=0.009), lower pH (p=0.043), lower serum bicarbonate (p=0.030), and lower partial pressure of O2 (p=0.022). In the first 10 minutes after extubation, the failed events were characterized by lower arterial (p=0.028) and cerebral NIRS (p=0.018) saturations. Failed events were associated with persistently lower values for cerebral NIRS 2 hours post-extubation (p=0.027). In multivariate analysis, vocal cord anomaly, cerebral NIRS at 10 minutes post-extubation, renal NIRS at pre-extubation and post-extubation, and end-tidal CO2 at pre-extubation remained as significant co-variates.Conclusions: Oximetric indices before, in the 10 minutes immediately after, and 2 hours after extubation and vocal cords paralysis are associated with failed extubation events in patients with parallel circulation.

OBJECTIVES: This study aims to determine whether bilevel positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP) effectively mitigate the risk of extubation failure in children status post-Norwood procedure. DESIGN: Single-center, retrospective analysis. Extubation events were collected from January 2015 to July 2021. Extubation failure was defined as the need for reintubation within 48 hours of extubation. Demographics, clinical characteristics, and ventilatory settings were compared between successful and failed extubations. SETTING: Pediatric cardiovascular ICU. PATIENTS: Neonates following Norwood procedure. INTERVENTIONS: Extubation following the Norwood procedure. MEASUREMENTS AND MAIN RESULTS: The analysis included 311 extubations. Extubation failure occurred in 31 (10%) extubation attempts within the first 48 hours. On univariate analysis, higher rate of extubation failure was observed when patients were extubated to CPAP/BiPAP relative to patients who were extubated to either high-flow nasal cannula (HFNC) or nasal cannula (NC) (16% vs 7.8%; p = 0.027). On multivariable analysis, the presence of vocal cord anomaly (odds ratio, 3.08; p = 0.005) and lower pre-extubation end-tidal co2 (odds ratio, 0.91; p = 0.006) were simultaneously associated with extubation failure while also controlling for the post-extubation respiratory support (CPAP/BiPAP/HFNC vs NC). CONCLUSIONS: Clinicians should not rely on CPAP or BiPAP as the only supportive measure for a patient at increased risk of extubation failure. CPAP or BiPAP do not mitigate the risk of extubation failure in the Norwood patients. A multisite study is needed to generalize these conclusions.